Organization
ARLINGTON NEONATAL INTENSIVE CARE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT C TISDELL (OWNER)
(817) 548-6514
Entity
Organization
Contact information
Practice address
800 W RANDOL MILL RD, ARLINGTON, TX 76012-2504
(817) 548-6514
Mailing address
PO BOX 120967, ARLINGTON, TX 76012-0967
(817) 548-6173
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G3859
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00T08E
BLUE CROSS
—
Enumeration date
01/29/2008
Last updated
01/29/2008
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